Storm Help Command
Welfare and Community Relief Request Form
This form is for the request for service or relief for church members or individuals in present need within the
Please fill out this entire form.
1301 - September 30 Hurricane (Main Org Event) (Emergency initiated on 2015-09-30 18:05:35)
845 - Moore, Oklahoma Tornado (Main Org Event) (Emergency initiated on 2013-05-23 11:13:00)
753 - Hurricane Sandy (Main Org Event) (Emergency initiated on 2012-11-07 15:49:43)
Work Order Prepared By
Home Owners Name:
Verify quadrant this home is located within (
Moore Quadrant A
Moore Quadrant B
Moore Quadrant C
Moore Quadrant D
Moore Quadrant E
Moore Quadrant F
City and ZipCode
Additional Directions To Home
Area Code and Number
Cell or Alternate Phone
area code and cell number
What Ward is This Homeowner Associated With?
Is Occupant Planning To Continue Living In Home?
Is This Home or Structure Habitable?
Home Owner Authorization
Has The Home Owner or Home Owner Representative Authorized The Following Release: RELEASE: I hold the volunteers, including their representatives and agents, harmless from any damage or injury that may occur on my property, including personal property. Further, I understand that no warranty or guarantee, express or implied, is provided for work performed on or for my property.
What is the name of the person giving authorization for work?
Please phone me to arrange a time for crews to work on the home. I want to be there when they arrive.
I don't need to be there when the crews arrive. I have taken any photos needed for insurance purposes and give permission for repairs and debris removal.
Name Of Person Making Assessment
Rain and Water Damage
Check Boxes Needed
Doors to be Removed
Sheet Rock and Insulation Removal
Carpet and Floor Covering Removal
Check Boxes Needed
Water on Main Floor
Number of 20' x 30' Tarp(s) Needed
Total Number of Trees Down
Number of Trees < 18" Diameter
Number of Trees > 18" Diameter
Is Heavy Equipment like Bobcats, Cranes, or Bulldozers Needed To Complete The Job?
Priority of Request
Return and Report
Please write the a description and notes of work that was done in the comments section. Please place your name, ward/stake and notes below. Also state if the task was done, partially complete, or nothing was needed. The number of others helped and neighbors you participated with. To see submitted work orders or status of them go to http://clients.fastcommand.com